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Early experience with pericardiectomy for constrictive pericarditis in Ile-Ife, Nigeria: a retrospective analysis
Olugbenga O Ojo1,2, Uvie U Onakpoya1,2, Oluwaseun R Akanbi2
1Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife.
Insights
Pericardiectomy effectively treats constrictive pericarditis, a cause of diastolic heart failure. This surgery significantly improves patient symptoms and functional status, with over 90% of survivors achieving better heart function post-procedure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Constrictive pericarditis is a rare cause of diastolic heart failure.
- Pericardiectomy is the primary surgical treatment for this condition.
- Common causes include idiopathic, mediastinal irradiation, post-cardiac surgery, and tuberculosis.
Purpose of the Study:
- To review the experience and outcomes of pericardiectomy at a tertiary hospital.
- To analyze patient demographics, surgical details, and postoperative results.
Main Methods:
- Retrospective study of 13 patients undergoing total pericardiectomy between January 2019 and December 2024.
- Data collected from clinical records included demographics, preoperative conditions, intraoperative details, and postoperative outcomes.
- Analysis of surgical duration, complications, ICU stay, mortality, and 12-month follow-up outcomes.
Main Results:
- The median patient age was 28 years; common symptoms were dyspnea and ascites.
- Most patients (61.6%) were in NYHA class III/IV and ASA II+.
- Pericardiectomy was performed via median sternotomy without cardiopulmonary bypass; average duration was 284.5 minutes. Postoperative complications included low cardiac output, acute kidney injury, coagulopathy, and pleural effusion. One mortality occurred. Median ICU stay was 2 days.
- Over 90% of surviving patients improved to NYHA class I/II at 12 months.
Conclusions:
- Pericardiectomy provides significant symptomatic relief for patients with constrictive pericarditis.
- Early diagnosis and intervention are crucial for preventing disease progression and improving patient outcomes.
Background:
Constrictive pericarditis is a rare but important cause of diastolic heart failure. Its uniqueness lies in the fact that surgery (pericardiectomy) remains the mainstay of treatment. Globally, the leading causes of constrictive pericarditis include idiopathic, mediastinal irradiation, post cardiac surgery and tuberculosis.
Methods:
Patients who underwent pericardiectomy at our tertiary hospital between January 2019 and December 2024 were retrospectively studied with the aim of discussing our experience with the procedure and its outcomes. Data including baseline demographics, preoperative conditions, intraoperative details, and postoperative outcomes were collected from clinical records and analysed.
Results:
Thirteen patients had total pericardiectomy during the period under review. The median age was 28 years with dyspnoea and ascites being the most common symptoms. Most patients (61.6%) presented in NYHA class III and IV and were above ASA II classification at the time of surgery. Pericardiectomy was done via median sternotomy and without cardiopulmonary bypass in all cases, with an average surgery duration of 284.5 mins. Postoperative complications included low cardiac output, acute kidney injury, coagulopathy, and prolonged pleural effusion. Median duration of intensive care unit (ICU) stay was 2days and there was 1 mortality. At twelve months follow up, more than 90% of surviving patients were in NYHA class I or II.
Conclusion:
Pericardiectomy offers symptomatic relief to patients with constrictive pericarditis. Early identification of this disease would prevent disease progression and offer improved outcomes.
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